Doctoring & Healthcare

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Empathy And Compassion For Transgender and Gender Non-conforming Children and Teens

gender-bathroomI saw this bathroom sign in my sons’ school a week ago. Talk about inclusion. I’m not only pleased that my boys are being exposed to open inclusion, I’m delighted they are getting the message that they can be whoever they are at home and at school. NO question in my mind the data proves if a child, teen or adult has questions about their gender their life is at risk for being harder. This is manifest in the high rates of anxiety and depression, bullying and ridicule, and feelings of isolation in those who are gender non-conforming and transgender. This is only estimated to be about 1% of the population (numbers are imprecise as many people hide this challenge) but how we all support those who question their gender matters for us all, the 99% of us who don’t have this challenge.

We must have compassion and empathy for children and teens who are transgender and gender non-conforming. We must accept children and teens and their families, and we can connect children and families who struggle with resources (below).

Children Are Born With Gender, Parenting Has Little To Do With It

  • Research shows that gender is established at birth. That means children are often born knowing if they are a boy or a girl irregardless of their sex (the chromosomes/genes that determine their body’s appearance and sexual characteristics). Sometimes children know this early, sometimes later in life.
  • Research shows that there is no evidence that parenting is responsible for a child having a different gender than their sex. Meaning — parents don’t have control, with their actions, over their child’s gender. They can’t change a child’s gender.
  • Research shows that children are less likely to end their life when they have challenges with their gender identity if they are accepted by their families. This means children who grow up in homes who accept them are less likely to suffer. Maybe a no-duh, but it’s something all parents should know.

This is complicated stuff, of course, and isn’t the same for all children and teens. Some children question their gender early in life (as early as preschool years) and will traverse childhood knowing they are transgender while other teens may find out at the onset of puberty that something isn’t quite right. Some children or teens just don’t identify with one gender or another (gender non-conforming). When they question this, we want to make sure they get what they need.

The most important message is that we must be open to what children express, connect children, teens and families with resources they need, and be aware of the risks for suffering in children who question their gender. Thankfully, there are lots of people to help and resources. Seattle Children’s Hospital now offers a specific clinic to support transgender and gender non-conforming children and teens (age 8-21 years). Experts and staff provide support for puberty blocking (stopping onset of pubertal development) or hormone therapy (hormones to have body characteristics match gender). They can also support conversations and planning for those who want to transition.

Statistics & Risks For Transgender Children And Teens

  • Transgender population is hard to define, probably less than 1% of adolescents
  • All gender non-conforming are at increased risk for bullying, anxiety, depression & suicide
  • 71% of transgender people said they hid their gender or gender transition to try to avoid discrimination

2014 Williams Institute Study On Transgender Issues:

  • 41% of transgender people attempt suicide
  • 57% report family choosing to not speak to them
  • Nearly 55% report being bullied and harassed
  • Nearly 70% experienced homelessness

What Communities & Parents Can Do & Teach:

  • If your teen has identified as a different gender since early childhood, it’s unlikely he or she will change their mind. Parenting won’t change this. Work on changing expectations, not your child.
  • When your child discloses his or her identity to you, respond in an affirming, supportive way.
  • Accept and love your child as they are. They will need your support and validation to develop into healthy teens and adults.
  • Stand up for your child when he or she is mistreated.
  • Be on the look out for signs of anxiety, insecurity, depression, and low self-esteem.
  • Connect your child with LGBTQ organizations, resources, communities and events. It is important for them to know they are not alone.

Online Resources For Children, Teens And Families

This list is from resources I found myself and from advocates for trans health. Any feedback on links included here is welcome — please comment!

  • National Center For Transgender Equality consider watching this video on Facebook where children, teens and families share stories about being transgender. Parents talk about fear, challenges with acceptance and discuss their safety. “The easiest way to support transgender people is to follow their lead” and “this is who I am” really do stand out.
  • Healthy Children article on transgender and gender non-conforming from American Academy of Pediatrics
  • Seattle Children’s Gender Clinic This has information on services and ways to see experts
  • Centers for Disease Control LGBTQ Resources overview information
  • The Trevor Project works to reduce severe depression and suicide in those questioning or struggling with their gender identity. They have a helpline (1-866-488-7386) and a chatline that you can connect with live.
  • My Trans Health – trans-friendly healthcare providers in Chicago, Dallas, Miami, NYC, San Francisco and Seattle
  • RAD Remedy (Referral Aggregator Database) described to me as a site, “dedicated to connecting trans, gender non-conforming, intersex, and queer folks to accurate, safe, respectful, and comprehensive care. Patients can review and rate providers on competencies and services provided.”
  • Seattle Children’s Gender Diversity Support Groups
  • Gender Diversity Family Support Groups
  • Social media: The trans community has an established presence on Instagram under certain hashtags, but has recently started cropping up more and more on Twitter with the hashtags #TransTakeover #ThisIsTrans #MomentsInTransition and #IamTransButAlso.

Community and A Conference

21091855984_fc2bb18bd0_kI feel so much gratitude every day. I feel it for near cliche reasons (my sweet babies, good health, shelter, opportunity to make change, perspective that seeing the world has afforded me, and the freedom we have living here in a democratic society). Sometimes gratitude overwhelms me. And unsurprisingly that’s typically true on the most challenging days of life; I don’t see and feel and smell my gratitude on the easy days as well as I do on the days when life taxes and feels uncertain. I sense the gratitude housed in me most when I’m leaning on those around me, when I cry or when I’m worried or lack control in a situation. And the reason is this: my gratitude is greatest for the people in my life and seems to swell when I feel a sense of belonging. For being alive, for being a part of something greater than myself, and for the luxury of being suspended, taught, and caught just in time by the net of those who have me. Who trust in me and in themselves that we have the courage to live with intention, compassion, and empathy and that we can dent the universe. Supportive communities change everything…

My work here at Seattle Children’s in building digital tools, partnering in the design of curriculum created by patients, and nurturing parent-to-parent support with digital technology is influenced wildly by my net of community, my witness to suffering, and of course, my own experiences of when communication fails in the health space.

Like a lot of people, I feel I have the most incredible friends and I do feel I have the most supportive community of co-workers, patients, colleagues, advisors, and entrepreneurs who nurture in me an ongoing will to keep trying out new things in the health space. Most of the people in my community and on “my team” are as passionate and desperate to see change as I am…

We all have a team. Most of us have multiple, of course. Sometimes we define team with our families, a group at work solving a unifying problem, or by the outlines of communities from childhood or other stages in life. Social networks have woven some of these teams into daily networks we historically couldn’t have had. Thank goodness that with networks, texts, social channels, cellular phones, and other intuitive technology we typically never have to be far from those who surround us.

My good friend Susannah Fox is the one who long ago said, “Community is Your Superpower.” She began to proclaim this after fastidious work to understand and describe some of early research in peer-to-peer health care while doing research at Pew Research Center and now works in government to serve patients around this country at large. But her point and her wisdom extends to every corner of of our lives. The wild power that comes from insight and expertise from those who are like us. Not just emotionally but with information, resource, and tactics to solve life’s vexing problems, together.


I mention all this because tomorrow around 4am I’m leaving my family in the dark to head to the airport to attend the Medicine X conference in Palo Alto. I’m joining dear friends, expert patients, entrepreneurs, nurses, executives, physicians, and artists as we gather to examine the opportunity of emerging technology to enhance our lives, solve health problems, hone solutions, and inspire diligence to making health care better. At Medicine X the patient voice is louder than at any other medical conference I’ve attended around the world. But more than anything as I ready to attend, I think of my visit as a return to a web of people and ideas that pour fuel into the center of me to keep thinking of ways to make change faster. Read full post »

Online Easy Access To Immunization Records

The digital health world recently took a step in the right direction when it comes to supporting access to your health care information. You can now be in charge of both your own and your family’s immunizations records in several states through a tool and online resource called MyIR (think “my immunization registry”). You can register yourself and your dependents and access to your official, consolidated immunization records on any device, any time. How great is that? No more calling your doctor’s office and asking them to fax your records over. Waiting for snail mail to deliver a copy is a thing of the past. For procrastinators with school paperwork, this is for YOU! With back to school rapidly approaching, now is the time to get your children up to date on their vaccines. And a great time for you to have unfettered access to the records.

New Immunization Record Access: MyIR

  • MyIR gives you access to your official, consolidated immunization records on any device, any time
  • Records get updated immediately after any new vaccine is given
  • Can be printed to give schools, athletic clubs and day cares
  • Available in: Alaska, Arizona, Louisiana, Washington & West Virginia

Here’s How To Get Your Immunization Record:

  • Visit: and register.
  • You can register yourself and any other family members
  • Verify: click Auto Match to have the site match your account with your state records
  • If Auto Match can’t find an exact match, click State Assisted Registration and follow steps (I had to do this and it was very efficient!).

myir auto matchmyir verify

2016 Vaccine Updates In Washington State

  • Last year, 85% of WA State kindergarteners had all required immunizations. Ideally we’ll get that up closer to 95%
  • Need 2 chicken pox shots documented this year. This year, schools are requiring documentation for all children in K-12 fro varicella vaccine. Parents need to make sure the school has the record to prove children have had both doses (given typically at 1 year and 4 year well child check-ups).
  • The flu vaccine is not required for school, but is safe and essential — flu vaccine is recommended for all children over 6 months of age.
  • Nasal flu vaccine not recommended this year — only option is the poke, but it’s the best bet at protecting your children from influenza!

HPV Vaccine Reminders

  • The HPV vaccine reduces the risk of cancer from HPV for boys and girls. It also reduces the likelihood of getting genital warts and lesions after teens or young women and men becomes sexually active.
  • All teens benefit: girls & boys receive 3 doses of the HPV vaccine starting at age 11. First dose at age 11 years, a second dose 2 months later, and a third dose at least 6 months after the first dose. If you wait a bit longer, the series doesn’t have to be restarted so get in to get the booster if you haven’t finished all three shots in the series!
  • No benefit in waiting!  The vaccine is proven more effective at younger ages (age 11 tends to give a more robust immune response than when giving the vaccine in later adolescence). There is no health benefit in waiting in immunize your teens — same pain with the poke but more time a teen could be exposed to HPV.


Read The Label And Know What Is In OTC Medicines

Quick reminders as we tidy our lives at the beginning of the school year. With little ones and children all heading back to school, we know it’s time to buckle down and get ready for the shift in schedules and in illness that comes with onslaught of viruses that come with preschoolers and elementary-aged kids back in the classroom. Before the fall is upon us, it’s a great time to really learn how to read the drug label and learn the ingredients, why or if it’s safe for a child the ages of your kids, why the inactive ingredients matter, and organize the cupboard! In some ways it’s combination medicines that make me worry the most — so this is a quick review on what you can do to feel confident when dosing and using OTC medications at home with your family.

Reading Over The Counter Labels & Dosing Liquid And Children’s Medicine:

1. Read the label.  Plain and simple get in the habit of always reading it as we don’t want to forget to make sure we really know what ingredients we’re giving and why. No question that sometimes we use medicines to “cure” children of illnesses, infections, or deficits (prescription antibiotics, anti-infectives, chemotherapy) but most OTC medicines only treat symptoms our children experience from infections or injuries. That makes them less necessary, although sometimes wildly helpful and soothing. Treating pain and discomfort is of course a priority for all parents when our children are uncomfortable! Consequently, we want to use OTC when they earnestly help and match the correct medicine with the symptom we’re targeting…the label can help.

reading labels 2

2. Know the ingredients — watch out for double dosing! So many products out there have combination medications. Many medicines for cough and cold will combine medicines for fever with medicines for mucus with medicines for cough. Some medicines combine medicines for allergy symptoms with medicine for fever. You might inadvertently be giving your child a second dose of acetaminophen (AKA “Tylenol”) when using a combination medicine without knowing it. Expert toxicology and pediatric emergency room friend, Dr. Suzan Mazor reminds, “that sneaky acetaminophen shows up in all sorts of combination medicines” so watch out! If you’re dosing acetaminophen for fever make sure you’re not double dosing if you’re also treating other symptoms with medicine.

3. The syringe or dosing cup -KEEP IT! Keep the dosing devices that comes with the OTC medicine you buy (use a rubber band as needed to attach it to the bottle)! No question that it is confusing to dose medicines based on weight. In the past, data finds that 98% of liquid OTC medications for children have inconsistencies, excess information, or confusing dosing instructions — thankfully this is changing and there is national push to have pediatricians write and explain doses only in milliliters or milligrams as opposed to dosing and explaining in “teaspoons” and “ounces.” As we work to standardize this there will still be some confusion. Read full post »

No Nasal Flu Vaccine This Year: Flu Shot For All Over 6 Months


Summer vacation has just started and it feels like the mild 2015-2016 flu season just ended. Here we are already hearing about new recommendations for the 2016-2017 season. Big news in the media today about flu vaccine: recommendations to only offer the shot (and no nasal flu spray) to improve children’s and public protection from the vaccine. Hundreds of children in the US die each year from influenza. We know the best way to protect against complications from influenza is to have families immunized. Flu vaccine is an every-year, essential vaccine as the strains included in the vaccine shift each year based on the types of flu predicted to spread across North America.

Recommendations For Pediatricians And Family Practitioners: Only Flu Shot For Families

Yesterday The American Academy of Pediatrics (AAP) endorsed the Advisory Committee on Immunization Practices (ACIP) recommendations to AVOID use of flu mist vaccine this coming flu season.  The Centers for Disease Control (CDC) will review the recommendations shortly; if CDC accepts the recommendation it will become official US policy.

We all want choice with vaccines and the nasal spray was a great option and a safe one. It was particularly effective during the 2009 H1N1 pandemic flu season and has been safe and very well received (no poke!) by families ever since for children over the age of 2. However, data from the past three years have found that it has been less effective in protecting children and their families from the most common strains of flu circulating (more below).

The nasal flu spray vaccine is still licensed and still safe. Because of recent data, this year to improve protection, ACIP is recommending only using the injected flu shot because it is far more effective at protecting against the strains of flu expected to arrive in the US.

That means a needle and quick poke for our kids. I talked to the TODAY Show about the recommendations this morning. I also talked with influenza and vaccine experts. Read full post »

Frozen Food Recall Because of Possible Listeria

frozen vegetablesBig recall, worth a glance from a frozen food company out of my home state of Washington. The Food & Drug Administration (FDA) issued a recall of 42 brands that sell frozen fruits and vegetables. It’s a BIG list of products that could be in your freezer if you shop at places like Costco, Trader Joe’s or Walmart. This is especially true if you’re pregnant, are immunocompromised or have young children. The possible contamination in these frozen foods is a bacteria called Listeria that can cause more significant illness in those groups. The recall includes over 350 products, both organic and non-organic, which are sold between these 42 brands. The Centers for Disease Control (CDC) notified the company that 7 people from 3 states have become ill and were hospitalized due to listeria, likely stemming from the consumption of contaminated frozen fruits and vegetables.

The FDA has a complete list of brands and products that are being recalled. Note that this recall affects all 50 states. All affected products have the best by dates or sell by dates between April 26, 2016 and April 26, 2018.

The bottom line: check your freezer for frozen fruits and veggies and then check the FDA’s list!  Throw out frozen fruits and vegetables if they are on the list. You can go back to the store where you purchased them and ask for a refund. Keeping them in your freezer is certainly not worth the risk of a Listeria infection. Children who ate contaminated foods and have normal immune systems are not at high risk of listeriosis, and no special testing is needed. Also, foods eaten more than 2 weeks ago are not worrisome, as the incubation period is 1-14 days.

What Is Listeria?

  • Listeria is a serious infection usually caused by eating food contaminated with the bacterium Listeria monocytogenes.
  • Common symptoms include fever and muscle aches, sometimes preceded by diarrhea or other gastrointestinal symptoms (vomiting). Most of us do okay after getting listeria and heal up without intervention but some people can have bigger risks (see below).

Who Is At High Risk:

Read full post »

Join In On The Seattle Mama Doc Podcast?

Always a work in progress here — trying to think on ways to share new data, expert advice & enjoy the journey of parenthood. I’m excited to announce we’re going to pilot a Seattle Mama Doc Podcast early next month. Since this blog’s inception in 2009 we’ve covered nearly 650 standard blog posts, vlogs, guest contributors, interviews and now I’m going to test out a podcast. I am a huge fan of crowd sourcing and co-design, so will you help create the look, feel and content of the podcast alongside me? I would love to know what topics you’re interested in, which you’re tired of hearing about, who you want me to interview and frankly, anything else you’d like to share.

My hope is to interview experts and researchers here at Children’s, parents, and patients when there’s interest in sharing the experience of raising children. We’ll include the smarts of friends and peers across the country working on preventing and preventing illness while raising children. We’ll highlight all the tips and tools we learn along the way, new evidence, expert opinion and ideas to feel better about our decisions while raising our children.

I’ve recorded 3 options for the introduction of my podcast (I’m well aware of kind of bootleg smartphone audio quality for these little demos — promise to record high quality content in studio for the actual podcast).

Which resonates and makes you want to tune in?

Tell me what to cover. And also, would you want to join me on the podcast? SAY SO, PLEASE!

Option #1


Option #2


Option #3


No Controversy, No Censorship — When Tribeca Got It Right

Screenshot 2015-02-01 12.30.40We don’t know what causes all autism but we do know vaccines don’t. Continuing to elevate myth does NO ONE any good. That’s why the Tribeca Film Festival got it right when pulling a documentary written and co-directed by vaccine science villain, Dr. Andrew Wakefield. Giving him another platform and more voice just isn’t insightful. To me it’s more noise and less what we need. There isn’t controversy here and there isn’t anything new to uncover. Allowing Wakefield more air time and the catapult generated by a film festival just ISN’T going to help us perfect parenthood and it won’t improve our jobs protecting our families, our children, and our communities. The Injustice of Immunization Interviews continues…

Tribeca Film Festival And Vaccines:

Wakefield is a doctor whose work connecting vaccines to autism was retracted from a medical journal (this is nearly UNHEARD of) and a doctor who lost his license to actually practice medicine. He’s not respected nor is his work something for us to learn from. His work may go down as one of the biggest frauds in medical history. Read: Wakefield’s article linking MMR to autism was fraudulent.

The science, on the other hand, is clear and well established. Vaccines have repeatedly and repeatedly been studied with respect to development of neurodevelopment changes and diagnoses on the autism spectrum. Don’t believe the preposterous things the politicians say. The 2011 comprehensive and enormous report from The Institute of Medicine analyzed over 1,000 studies on adverse side effects from vaccines. They concluded, “the evidence shows there are no links between immunization and some serious conditions that have raised concerns, including Type 1 diabetes and autism.” (read more here)

Ongoing research, motivated primarily because of the distrust and fear for vaccine safety propagated in movies, media, and documentaries alike continue to find the very same thing. Science continues to come out on the side of vaccines. Vaccines have adverse effects (fever, pain, seizure, and fainting, for example) but not autism. Read full post »

New Birth Control Laws: Preventing Unplanned Pregnancy

Birth ControlEasy, confidential access to affordable birth control is essential if we’re going to decrease the rate of unplanned pregnancies. The dynamics of birth control access are changing, thank goodness. As we’ve heard about parts of the world simply telling women NOT to have babies (Hello, Ecuador) we really do have to think about how women and men prevent pregnancy when not ideal. And how we support women getting information they need to make the safest and most reliable choice. This can start way before teens are sexually active.

Things are changing here in the US. As of Jan. 1, 2016 women 18 and older in Oregon can get hormonal contraceptives directly from a pharmacy, without having to go to a doctor for a prescription first. Pharmacists who supply birth control are required to complete formal training before being allowed to write prescriptions. In addition, teens and women must take a 20-question health assessment before obtaining the prescription that details risks and family history. This is why I always want parents to tell their teen if there is a family history of blood clots, family history of migraines, etc. That way, they can answer correctly!

The good news, here in the US, contraception is covered by insurance and protected by Obamacare (Thank you, Mr. President). Birth control options covered by the Affordable Care Act include: IUDs, emergency contraception, implants, pills, patches & rings.

California has also passed similar legislation that will take effect in the coming months to make it even easier for women to access birth control. National work is ongoing as well to make birth control over-the-counter. More on that to come!

When it comes to teaching our teens about sexual education, we know the topic is fraught with contentious beliefs and cultural sensitivities, and we also know that it’s really hard to speak about certain topics openly. But over and over, we are told by our kids that it’s us – the parents – their trusted adult community – they want to hear from most. Even when they squirm in the seat, DO KNOW THEY ARE LISTENING. I’ve written about this before for parents preparing those kids going off to college.

But really, talking to your teens about how to protect their bodies from sexually transmitted diseases, unplanned pregnancies, or violence should start much earlier. Normalizing the conversation appropriately for kids as young as five is encouraged in many parts of the world. We can talk about how we time growing our families in age-appropriate contexts. I’m thinking of writing a post, in partnership with a health educator, about what to say to a 5 year-old, an 8 year-old, an 11 year-old, and a 15 year-old. Would that be helpful? Please leave a comment…

I also want to offer a few great resources, thanks in part to my friend, teen advocate and digital educator, Susan Williams (@estherswilliams) for other parents to use as additions to or as guides for helping their kids understand their bodies and their decisions when it comes to sex and relationships.

There are three initiatives underway that I believe are truly shifting how sexual education and access to the right care, contraception, and information is achieved. Being able to get the right information when you need it and then being shown how to act on that information is crucial to preventing unplanned pregnancies and reducing cases of STDs. For adults who love their (our!) kids, we also need resources to help guide how we talk about sex:  Read full post »

Yes To No Tobacco Until Age 21

Teen smokingHear me straight: we don’t want anyone addicted to tobacco products. No question it’s an ugly habit and a terribly complex addiction. Expensive, detrimental to health, so very ugly… So I’m all for WA State House Bill 2313 (SB 6157) supporting moving the purchase age of tobacco from 18 to 21. Yes I know you can vote and enlist in the military at 18, but inconvenient or not, teen brains are not fully developed by the time they enter college-age and the effects of nicotine and the trend towards lifelong addiction are seriously grim. Complain all you want that Washington would be a “nanny state” but the facts are clear: if you start smoking at a young age, odds are that you will still be smoking as an adult. We know that more than 80% of all adult smokers begin smoking before the age of 18; and more than 90% do so before leaving their teens. We need to get tobacco out of reach so we can stop addiction before it starts. This isn’t just about public health it’s also about the health care spending of your tax dollars.

My friend and colleague Dr. John Wiesman (WA Secretary of Health), gave a press conference this week on the new bill. Here are a few staggering excerpts from his speech:

Counting cigarettes, smokeless tobacco, and e-cigarettes together, in 2012, 12 out of every 100 10th graders used these products, and by 2014 that number had risen to 20 out of every 100. That’s a frightening 67%  jump in just 2 years!

Both cigarettes and e-cigarettes set kids up for a lifetime of addiction and poor health.

The most effective way to stop this trend is to stop our kids from smoking before they start.

Middle school, high school and college students are still undergoing significant brain development.

Nicotine exposure during this critical time appears to affect the structure and function of the brain and may lead to lasting cognitive and behavioral impairments.

If that’s not enough reasons to support this work, I don’t know what is. But, here’s one last piece of data that will hit you square in the wallet (ouch). Each year in Washington alone, we spend: Read full post »